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Different acute-phase response in newborns and infants undergoing surgery
Edwin Bölke1, Peter M Jehle, Matthias Trautmann
1Department of Surgery, University of Ulm, D-89075 Ulm, Germany.
Insights
Neonatal surgery for gastrointestinal malformations did not trigger significant inflammatory markers like endotoxin. However, infants undergoing stoma reversal showed increased endotoxin and inflammatory responses, likely due to gut bacterial colonization.
Area of Science:
- Pediatric Surgery
- Neonatal Immunology
- Surgical Inflammation
Background:
- Surgical trauma can elicit inflammatory responses.
- The inflammatory response in neonates post-surgery is not well understood.
- Gut bacterial colonization may influence inflammatory responses to surgery.
Purpose of the Study:
- To compare the inflammatory response in neonates undergoing major abdominal surgery with infants undergoing elective stoma reversal.
- To investigate the role of endotoxin, IL-6, and C-reactive protein in surgical inflammation in different age groups.
Main Methods:
- Prospective clinical study comparing two groups: neonates (n=88) with congenital malformations and infants (n=20) with temporary stoma.
- Measurement of plasma endotoxin, IL-6, and C-reactive protein, and leukocyte counts during and after surgery.
- Statistical analysis using the Wilcoxon signed-rank test.
Main Results:
- Infants showed a significant increase in circulating endotoxin and leukocyte shift, with IL-6 peaking at 2-6h and C-reactive protein at 24h post-surgery.
- Neonates generally did not exhibit significant increases in these inflammatory markers, except for those with gastroschisis.
- Neonates with gastroschisis had a less pronounced inflammatory response compared to older infants.
Conclusions:
- Neonates may have a blunted inflammatory response to surgical trauma compared to older infants, potentially due to immature gut bacterial colonization.
- Endotoxemia following surgical trauma is not observed in newborns, likely because their gastrointestinal tract is not yet colonized by bacteria.
- Further research is needed to fully elucidate the mechanisms of inflammatory response modulation in neonatal surgery.
Abstract:
In a prospective clinical study, we investigated the inflammatory response in 88 neonatal subjects (43 boys and 45 girls) who underwent major abdominal surgery owing to congenital malformation involving the gastrointestinal tract and compared it with the response in 20 infants (8 boys, 12 girls; mean age, 4 mo) who underwent elective surgery for resolution of an existing temporary stoma. In both groups, plasma levels of endotoxin, IL-6, and C-reactive protein as well as leukocyte counts were determined during and after surgery. Endotoxin was measured by the Limulus amebocyte test, IL-6 by ELISA, and C-reactive protein by nephelometry. Statistical analyses were performed using the Wilcoxon signed-rank test. A significant increase in circulating endotoxin and a leukocyte shift was observed in the infant group only. Postoperatively, IL-6 levels peaked between 2 and 6 h and C-reactive protein after 24 h in the infant group. In contrast, no significant increase in the levels of endotoxin, IL-6, and C-reactive protein in plasma were observed during and after surgery in the neonatal subjects, except those with gastroschisis. Newborns with gastroschisis developed an inflammatory response after surgery that was less pronounced than the response of infants older than 4 mo. The finding that endotoxemia in newborns does not follow surgical trauma is most likely because of the absence of bacterial colonization of the gastrointestinal tract.
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